Diet and coronary artey disease

CORONARY HEART DISEASE is the modern epidemic facing the developing world. Among all the modifiable risk factors ,diet plays an important role in all of them. adequate knowledge is the first step towards behaviour change . in this presentation I have tried to impress upon food items which are beneficial as well as harmful for individuals having risk factors or disease . hope it will stimulate the viewer to understand and change the eating habits in the society.

1. DIET AND CORONARY HEART
DISEASE
DR.HARIVANSH CHOPRA
PROFESSOR & EX. HOD
COMMUNITY MEDICINE
LLRM MEDICAL
COLLEGE,MEERUT
[email protected]
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2. OBJECTIVES :
•To study the risk factors
of CHD.
•To know about the
effect of various dietary
components on CHD.
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3. OBJECTIVES :
•To find out which type
of diet is good in CHD
and in CHD with other
risk factors.
•Lastly, to know how
the effects of CHD
can be reversed.
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4. RISK FACTORS OF CORONARY
HEART DISEASE
Risk Factors:
Modifiable Non Modifiable
Major Minor
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5. Major Minor
Hypertension
Smoking
Diabetes
Obesity
Elevated Cholesterol
Physical Activity
Mental Stress
Oral Contraceptive
Trace Elements
Homocysteinemia
Modifiable Risk Factors
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6. Non Modifiable Risk Factors
Age
Sex
Family History
Genetic Factors
Personality
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7. Of these, four factors require
dietary modifications –
Diabetes
Obesity
Elevated Cholesterol
Homocysteinemia
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8. DIABETES MELLITUS :
oSymptoms of diabetes + random
blood glucose > 200mg/dl or
oFasting blood glucose >126mg/dl
or
o2 hr plasma glucose > 200mg/dl
during oral glucose tolerance test.
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9. HYPERCHOLESTEROLEMIA
Desirable levels of serum cholesterol -
<150mg/dl.
When the levels are more
than 250mg/dl –
hypercholesterolemia.
(desired levels of LDL cholesterol -
<100 mg/dl.).
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10. Hypercholesterolemia
Genetic Dietary
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Endocrinal

11. Hypercholesterolemia
Genetic Dietary
Non –modifiable by
diet Alone. Need other
methods like yoga,
exercise, meditation,
statins , plasmapheresis
PCSK9 INHIBITORS
Modifiable by
diet
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Metabolic

12. OBESITY :
Defined as an abnormal
growth of the adipose
tissue due to an
enlargement of the fat
cell size or an increase in
fat cell number or a
combination of both.
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13. According to BMI :
Underweight <18.5
Normal 18.5 –24.9
Overweight >25.0
Preobese 25-29.9
Obese class 1 30-34.9
Obese class II35-39.9
Obese class III> 40.0
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14. HOMOCYSTEINEMIA :
Refers to increased total
plasma concentration of
homocysteine in the
sulfhydryl and disulfide
group,free and protein
bound.
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15. FAMILY HISTORY :
Defined as the presence of the
health condition under consideration
in one’s siblings or parents or
grand –parents < 60 years old. Usually
genetically determined.
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16. ROLE OF DIET IN
HEALTH AND
CORONARY HEART DISEASE
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17. Lets see how much energy is required for
various activities !
Sleep 0.6 cal/min.
Reading 1.4 cal/min.
Eating 1.8 cal/min.
Converse 1.8 cal/min.
Writing 1.9 cal/min.
Standing 2.2 cal/min.
Casual walking 4-5 cal/min.
Running 10-12 cal/min.8/20/2020 17

18. •This energy requirement for the
different activities a person does
in a day can be provided by a
balanced diet in a normal
healthy individual.
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19. BALANCED DIET :
This is the
recommended diet
in a normal
healthy individual
without any risk
factors for
Coronary heart
disease.
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20. WHAT IS IT ?
15%-20% Proteins
20%-30% Fats
Rest Carbohydrates .
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21. Dietary modifications
in CHD are required
because of the
following reasons !
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22. •The SevenCountries Study
showed a strong positive relation
between saturated fat intake
and the 10 year incidence of
CHD.
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23. •Body weight changes
are strongly related to
changes in serum total
cholesterol and blood pressure.
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24. •Population subgroups
consuming diets rich in
plant foods have lower
CHD rates than
the general population.
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25. •Diet therapy should be
the first step in the
treatment of
Hypercholesterolemia.
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26. Lets Take the Various
Components of Diet
One by One !
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27. MILK :
Whole milk has
a cholesterol
lowering effect.
Thus , a cup or
two is permitted.
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28. EGG :
White of egg has
no fat and thus does
not raise cholesterol.
So, one or two eggs
per day are safe.
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29. NUTS :
28g of walnut with
each of the three
meals without
increasing total
dietary fat
improves serum
lipid profile.
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30. MEAT :
•No significant
change in plasma
cholesterol when
diet self selected
for beef , pork,
poultry or fish.
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31. •But some studies reveal
increased plasma total cholesterol
and systolic blood pressure
with meat.
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32. •SAAOL Diet prohibits
the intake of meat
in any form.
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33. SOYABEAN :
In typeII
hypercholesterolemic
patients already on a
low lipid, low cholesterol
diet, substitution of
animal protein by
soyabean reduced
cholesterol.
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34. GARLIC AND ONIONS :
•Good effect noted with
high doses.
•Lower blood pressure,
prevent coronary
thrombosis, heart
attacks and strokes.
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35. OTHER VEGETABLES:
•Capsicum increases
fibrinolytic activity in
blood –reduced
chances of thrombo
embolism.
•Sour foods precipitate
anginal attacks.
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36. FIBRES :
Two types –soluble & insoluble.
•Filling with fewer calories.
•Add roughage to the diet.
•Aid digestion and elimination.
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37. Soluble fibers in addition-
•Lower total blood cholesterol.
•Lower LDL cholesterol.
•Regulate blood sugar.
•Favorable effect on blood
pressure.
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38. SOURCES OF SOLUBLE FIBERS :
•Oat bran
•Rolled oats
•Broccoli
•Brussels sprouts
•Grapefruit
•Apples .
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39. Plant foods :
Beneficial factors
include –
•relative energy content
•fiber content
•unsaturated fatty acids
•anti oxidant properties.
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40. BEVERAGES :
More intake of coffee leads
to –
•Raised serum cholesterol
•Irregular heart beats
Consumers of real boiled
coffee face higher risk.
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41. ALCOHOL :(controversial role)
Increases HDL cholesterol (HDL3
but not HDL2) in marathon
runners and inactive men but not
in men who run and jog.
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42. Daily consumption of one
or two pegs of whisky
or 1-2 glasses of beer
not harmful but beneficial
to heart patients. ????
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43. WATER :
•CVS mortality 10% higher
in areas with very soft water
as compared to medium
hard water.
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44. •In areas where water supply
changed in the last 30 years
favorable effect seen when
water became harder and
unfavorable when it became
softer.
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45. MINERALS :
•Silicon deficiency –atherosclerosis
•Cadmium –toxic to heart
•Low Selenium associated with CHD
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46. ROLE OF FREE RADICALS:
•By-product of oxidation.
•Damage cell membranes, disturb
chromosomes and genetic material
and destroy valuable enzymes.
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47. •Cause 50% of CHD, lung diseases
certain cancers, cataracts, rheumatoid
arthritis, Parkinson’s disease etc.
•2 ways to reduce them –
1.Less consumption
2.Anti-oxidants.
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48. Anti-oxidants
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sulphur compounds–leeks, onions and garlic
anthocyanins–eggplant, grapes and berries
beta-carotene–pumpkin, mangoes, apricots, carrots,
spinach and parsley
catechins–red wine and tea

49. Anti-oxidants
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copper–seafood, lean meat, milk and nuts
cryptoxanthins–red capsicum, pumpkin and
mangoes
flavonoids–tea, green tea, citrus fruits, red wine,
onion and apples
indoles–cruciferous vegetables such as broccoli,
cabbage and cauliflower

50. Anti-oxidants
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isoflavonoids–soybeans, tofu, lentils, peas and
milk
lignans–sesame seeds, bran, whole grains and
vegetables
lutein–green, leafy vegetables like spinach, and
corn
lycopene–tomatoes, pink grapefruit and
watermelon

51. Anti-oxidants
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manganese–seafood, lean meat, milk and
nuts
polyphenols–thyme and oregano
selenium–seafood, offal, lean meat and
whole grains
vitamin A–liver, sweet potatoes, carrots,
milk, and egg yolks

52. Anti-oxidants
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vitamin C–oranges, blackcurrants, kiwifruit, mangoes,
broccoli, spinach, capsicum and strawberries
vitamin E–vegetable oils (such as wheatgerm oil),
avocados, nuts, seeds and whole grains
zinc–seafood, lean meat, milk and nuts
zoochemicals–red meat, offal and fish.

53. So, diets suggested when one
or more risk factors present
but no history of CHD are -
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54. Presence of Hypertension or Family History:
Fats 20-30%
Saturated fats <10%
Dietary cholesterol <300mg/1000kcal/day
Increased consumption of complex carbohydrates
Salt intake <5g/day.
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55. Presence of Hypercholesterolemia
•A two step diet is suggested.
•The goal is to reduce the total
cholesterol to less than 150mg%
and LDL cholesterol to less than
100mg%.
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56. •If after a trial period of 2-
6 months, the Step I diet
fails to lower the
cholesterol then one
should switch to the Step
II diet.
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57. Two step dietary therapy –
Step one –
Fats <30%
Saturated fats <10%
Dietary cholesterol <300mg/day.
PUFA up to 10%
MUFA 10-15%
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58. Carbohydrates 50-60%
Proteins 10-20%
Total Calories - to achieve
and maintain
desirable weight
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59. Step Two -
Fats <30%
Saturated fats <7%
PUFA upto 10%
MUFA 10-15%
Dietary cholesterol <200mg/day.
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60. Carbohydrates 50-60%
Proteins 10-20%
Total Calories to achieve
and maintain
desirable weight
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61. OBESITY:
•Proportion of energy
dense food should be
reduced,
•Fiber content to be
increased,
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62. Obesity
•Adequate levels
of essential
nutrients in the
low energy diets
•Food energy
intake should not
be greater than
energy expenditure.
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63. DIABETES MELLITUS :
Proteins 10-20%
Saturated fat <10%
PUFA <10%
Carbohydrates rest calories
+ MUFA
Fiber 20-35g/day
Sodium <3g/day
Cholesterol intake <300mg/day8/20/2020 63

64. HOMOCYSTEINEMIA :
•Diet rich in folate
or
•Consumption of
multivitamin
supplements
recommended.
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65. DIET IN
CHD PATIENTS
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66. SAAOL DIET:
65%-70%
carbohydrates
20%-25% proteins
10% fats (invisible)
No visible fats.
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67. FOOD ITEMS TO BE AVOIDED
Milk (full cream)
and Milk products.
Skimmed milk
beyond 200ml/day.
Cheese and Butter.
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68. Butter milk (Lassi)
beyond 200 ml of milk.
All kinds of non-
vegetarian items.
Nuts and Dry Fruits.
Sweets and all types
of oil.
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69. FOOD ITEMS MODERATELY
RESTRICTED
Brown bread and
white bread.
Rice.
Vermicelli.
Bajra, Jowar,
Maize, Wheat
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70. Peas.
Potato, Sweet potato,
Arbi.
Jaggery, Sugar.
Banana, Mango.
Cold drinks.
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71. FOOD ITEMS WHICH CAN BE
CONSUMED FREELY
Cereals –puffed rice,
chiwra.
Pulses –chana, moong,
urad, soyabean,etc.
Leafy vegetables.
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72. Roots and Tubers –carrot,
onion, white radish, garlic, ginger.
Other Vegetables –beans,
brinjal, cucumber, pumpkin, lady
finger, tomato, capsicum, kakri,
mushrooms.
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73. Fruits –apple,
guava,
orange,
watermelon,
papaya, pineapple,
ripe tomato, lemon.
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74. Now lets see the type of
diet to be taken in CHD
patients with one or
more risk factors.
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75. Reversal diet :
•10% fat (mostly
polyunsaturated or
monounsaturated).
•70-75%
carbohydrates.
•15-20% proteins.
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76. •5 mg cholesterol / day.
•Allows but does not
encourage moderate
alcohol consumption.
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77. •Excludes all oils and
animal products
except non fat milk
and yogurt.
•Allows egg white.
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78. •Excludes caffeine
and other stimulants.
•Allows moderate use
of salt and sugar.
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79. CONCLUSION :
Modification of diet goes a
long way in prevention of
CHD especially in those
people having multiple risk
factors.
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80. Dietary management
will further decrease
those risk factors and
the occurrence of
CHD.
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81. In persons already suffering
from CHD, right kind of
dietary management will
By pass the need for
interventions and bypass
surgery.
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82. 82
Avoid alcohol
Be physically active
Cut down on salt and sugar
Don’t use tobacco products
Eat plenty of fruits and vegetables
Being healthy is as easy as ABCDE